Evaluation of pharmacy resident and student recommendations made before and after home-based primary care patient...

To compare the types of recommendations documented in pharmacy resident and student home-visit notes with those made in the electronic medical record-based drug regimen review (DRR) notes.

San Francisco Veterans Affairs Medical Center (SFVAMC), San Francisco, California.

The SFVAMC Home-Based Primary Care (HBPC) program provides primary care services through an interdisciplinary team. The pharmacist performs a DRR-a federally required, quarterly retrospective review of the medications for each patient enrolled in the HBPC program and acts as a preceptor for pharmacy residents and students helping to provide patient care.

Starting in 2008, residents and students began making home visits with the HBPC primary care providers. Activities and recommendations were documented in a home visit clinical note.

Number and types of recommendations documented during the DRR and in the home visit notes as well as the clinical change in disease states based on the accepted recommendations.

Ninety-three recommendations were accepted: 27 DRR recommendations and 66 home visit recommendations from August 1, 2008, to July 31, 2009. The most commonly accepted DRR recommendations were to evaluate response to therapy (29%) and home visit recommendations to document medications not listed in the medication profile (26%). Clinical change in disease state based on the majority of the accepted recommendations remained unchanged for both DRR and home visit recommendations.

Home visits by pharmacy residents and students resulted in a greater number and different type of recommendations documented in their home visit notes compared with those in the DRR notes.